Transcript Where is My Doctor? Human Resources for Health - Gender and Reproductive Rights Perspectives. By Olufunke (Funke) Akiyode Shout Global Health.

Where is My Doctor? Human
Resources for Health - Gender and
Reproductive Rights Perspectives.
By
Olufunke (Funke) Akiyode
Shout Global Health
Who are Health Workers?
• The World Health Organization (WHO) defines a
health care worker (HCW) as anyone whose focus or
activity is to improve health. They are people
engaged in the promotion, protection or
improvement of the health of the population. This
includes “family caregivers, patient-provider
partners, part-time workers, health volunteers and
community workers”
• HCW can also be classified into three groups
providers, technicians and managers1. (World Health
Organization. World health report 2000: health
systems: improving performance. Geneva: WHO;
2000)
Who are Health Workers?
The WHO also classified health workers into the
following categories:
• Physicians
• Nurses and Midwives
• Dentists and dental assistants
• Pharmacists
• Laboratory scientists and technicians
• Environment and public health workers
• Community health workers and traditional
healers
• Other health care providers
• Health managers and support workers2
Doctor - Patient Ratio (DPR)
• The number of doctors per patient is
known as the Patient Doctor ratio.
• It is also referred to as doctor
population ratio, and patient - doctor
ratio.
• The WHO recommended doctor –
patient ratio is 1:600 (one doctor per
600 patients)3
Why are Doctor – Patient Ratio/ HCW
Issues important?
India – during the bird flu pandemic – “It got
media attention recently, when the bird flu
broke out in different part of our country. It also
grabs media attention in
complicated/emergency situations, when the
rural doctors ask the about-to-collapse patients
to rush for trauma centers in the city hospitals.
And many patients die on their way to the
Intensive Care Unit (ICU) of the sophisticated
hospitals located in the urban areas” 4
Why are Doctor – Patient Ratio/ HCW
Issues Important?
• Low patient doctor ratio will reduce the
general health status
• It increases the waiting time to see a doctor
• Less time spent with a doctor
• Errors in diagnosis
• Patient not receiving medical care
• All these can increase both maternal and
infant mortality rates
Facts about Doctor Patient Ratio
• It varies within countries and between
countries
• Usually there is a lower Doctor patient ratio in
urban areas than in rural areas For example
ratio of doctor to patient in the urban area in
India is 1:1700 and for the rural population it
is as high as 1:30,0005
• Doctor to patient ratio is lower in high income
countries compared to low income countries.
For example the ratio is 1:50,000 in Tanzania
and 1:320 in Netherlands6
Facts about Doctor Patient Ratio/ HCW
• In 15 countries in sub-Saharan Africa, there are
five or fewer physicians per 100,000 people –
below the recommended 20 physicians per
100,000
• Countries with less than 2.5 HCWs per 1,000
people were unable to provide 80% coverage
for measles immunizations and deliveries by
skilled birth attendants 7
• World Health Report from 2006 estimates that
Africa and Asia together lack more than 4
million health workers8
Crowds gathering around a mobile health
station in India9
Global Variation in Doctor – Patient Ratio
High Income DPR
Countries
Low
Income
Countries
Ethiopia
DPR
United
1:390
States
Netherlands 1:320
Tanzania
1: 50,000
Burundi
1: 33,500
Japan
1: 500
Mali
1: 12, 500
Canada
1: 470
Haiti
1: 4, 000
Great Britain 1: 440
1: 33,500
High DPR and General Health Status Indicators
(MMR, IMR, MR)
Country
DPR
Ethiopia
1: 33,500 101 / 1,000 470/
Tanzania
Burundi
Mali
Haiti
Infant
Mortality
Rates
MMR
100,000
578/
1: 50,000 66.93/
1000
100,000
1: 33,500 70.4 / 1000 1000/
100,000
580/
1: 12, 500 111.34/
1000
100,00
1: 4, 000
74 /1000
520/
100,000
MR
11.04/1000
12.09/1000
13.89/1000
14.29/ 1000
8.21/ 100010,11
Low DPR and General Health Status
Indicators (MMR, IMR, MR)
Country
DPR
Infant
Mortality
Rate
MMR
MR
Great Britain 1: 440 4.62/1000
7/100,00
10.2/1000
United
States
8/ 100,000 8.03/
1000
1:390 6.06/1000
Netherlands 1:320 10.37/ 1000 7/100,000 8.74/1000
Japan
1: 500 3.28/ 1000
8/100,000 9.54/
1000
Canada
1: 470 4.82/1000
5/100,000 7.74/
100011
Analysis of DPR and General Health
Status
• Countries with high DPRs have
high infant mortality , maternal
mortality and crude death rates
• Countries with low DPRs have
low infant mortality, maternal
mortality and crude death rates
Global Variation in HCW and Burden of
Disease
• Africa carries 25% of the global burden of
diseases but has 3% of the global health
care workers
• Americas and Europe both carry 10% of the
global burden of disease but 28% and 37%
of the global health care workers
respectively12.
• Thus, we may conclude that the higher the
health care workers, the lower the burden
of diseases
Global variation in HCW and Burden of
Disease
7
Doctor to Patient Ratio and Maternal
Mortality
“Pregnancy is not a disease, a woman
should not die of pregnancy…it
doesn’t need a new drug…it doesn’t
need research – we just need skilled
workforce at different levels,” Seble
Frehywot of GWU 13
Doctor to Patient Ratio and Maternal
Mortality
• Increased access to skilled health workers
during pregnancy and delivery, including
midwives and other practitioners, can
significantly reduce maternal mortality in
developing countries
• Many healthcare systems are faced with
shortage of anesthesiologists, surgeons and
obstetricians 14
• Maternal mortality reduction shows the
greatest sensitivity to the presence of
skilled maternal health providers 15
7
Doctor to Patient Ratio and Maternal
Mortality
• The higher the density of health
workers , the higher the probability
of infant survival, child survival and
maternal survival.
• Thus the lower the DPR, the lower
the maternal mortality rates and
vice versa
Gender and Doctor to Patient Ratio
• The low number of health workers
places a burden on women as the
traditional care givers in many
countries
• The girl child might be denied basic
needs like education, and social life
in order to take care of the sick and
elderly
Doctor to Patient Ratio and
Reproductive Health
• Reproductive Health has been defined
according to the International Conference on
Population and Development as a ‘state of
complete physical, mental and social well being
and not merely absence of disease or infirmity
in all matters relating to the reproductive
system and to its function and processes’
• In countries and places where there is a
shortage of HCW, women will lack access to full
sexual and reproductive health care for example
family planning services, and so on.
Doctor Patient Ratio and Reproductive
Health Rights
• Reproductive health right as defined in the
Beijing Platform of action are certain human
rights recognized in the national and
international legal and human rights documents,
including the basic rights of all couples and
individuals to decide freely and responsibly the
number and spacing of their children, and to have
information, education and means to do so; the
right to make decisions concerning reproduction
free of discrimination, coercion and violence
Doctor Patient Ratio and Reproductive
Health Rights
• Low HCW will reduce access to
reproductive health information and
education
• Thus violating RHR
• Low access to family planning
service, a violation of their RHR
Conclusions and Recommendations
• To improve women’s RH and RHR, it is obvious
that the density of HCW in many places in the
world needs to be drastically increased
• Some of the suggested ways include:
• Short run
• Move jobs from one sector to another and from
urban areas to rural areas with incentives
• Long run
• Admit more qualified students into the medical
schools
• Employ Physician Associates
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